Healthcare Provider Details

I. General information

NPI: 1902164213
Provider Name (Legal Business Name): LIFE CYCLE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 HOUND DOG TRL
SAINT HELEN MI
48656-9538
US

IV. Provider business mailing address

1107 HOUND DOG TRL
SAINT HELEN MI
48656-9538
US

V. Phone/Fax

Practice location:
  • Phone: 989-307-0205
  • Fax: 989-632-3325
Mailing address:
  • Phone: 989-307-0205
  • Fax: 989-632-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD ELMER JAMES
Title or Position: PSYCHOLOGIST
Credential:
Phone: 989-307-0205